Surgical Ethics: Principles and Practice

313 Pages·2019·6.354 MB·English

by  Alberto R. Ferreres

Surgical Ethics
Principles and Practice
Alberto R. Ferreres
Editor
123
Surgical Ethics
Alberto R. Ferreres
Editor
Surgical Ethics
Principles and Practice
Editor
Alberto R. Ferreres
Department of Surgery
University of Buenos Aires
Buenos Aires
Argentina
Department of Surgery
University of Washington
Seattle, WA
USA
ISBN 978-3-030-05963-7 ISBN 978-3-030-05964-4 (eBook)
https://doi.org/10.1007/978-3-030-05964-4
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Preface
This textbook Surgical Ethics: Principles and Practice is devoted to dissemi-
nate the foundations and implications of ethics in the surgical arena, the so-
called surgical ethics. Theoretical ethics attempts to understand the underlying
grounds, assumptions, and concepts of ethical systems; meanwhile, practical
ethics is related to the application of ethical standards in everyday surgical
practice and care. This book attempts to provide acting surgeons in the differ-
ent fields with a thorough and deep practical insight of the field of ethics as
well as tools for solving ethical conflicts in everyday care.
Surgery is characterized by some unique features: it harms before healing,
penetrates the patient’s body, and thus is highly invasive; decision-making is
performed many times under conditions of uncertainty and is prone to risks,
errors, accidents, complications, and sequelae. Thus, surgery is a moral prac-
tice, and as such, the surgeon becomes a moral fiduciary agent for his or her
patient. Trust is paramount to build an effective and beneficial patient- surgeon
relationship, placing the patient at the center of our fiduciary care.
Ethics lies at the core of surgical professionalism: surgeons should not
only achieve surgical competence and diligence but also need to be ethically
and morally reliable. In this way, an outstanding quality of care will be offered
to all members of our society.
I want to specially thank all the coauthors, leaders in their fields, who have
done an amazing job. Their collaboration has been outstanding, and without
their participation, this book would not be in your hands today.
My eternal gratitude to Dr. Carlos Pellegrini, a true beacon in my aca-
demic life and instrumental in allowing me to contribute to this field at the
University of Washington, Department of Surgery. He and his wife Kelly
have been long-standing friends, mentors, and supporters.
A special mention to our Editor Mr. Prakash Jagannathan, whose role was
fundamental and was highly effective in guiding our efforts.

Buenos Aires, Argentina Alberto R. Ferreres
v
Contents
Part I P rinciples and Foundations of Surgical Ethics
History and Development of Medical Ethics In the West . . . . . . . . . . 3
Georgina D. Campelia and Denise M. Dudzinski
The History of Surgical Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Jukes P. Namm and Cassandra C. Krause
Surgical Ethics: Theory and Practice Background . . . . . . . . . . . . . . . 27
Douglas Brown
Foundations and Principles of Surgical Ethics . . . . . . . . . . . . . . . . . . . 45
Alberto R. Ferreres
The Ethical Challenges of Surgical Leadership . . . . . . . . . . . . . . . . . . 53
E. Christopher Ellison
What Is Surgical Professionalism? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Steven M. Steinberg and Andrew L. Warshaw
Ethics in Academic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Charles W. Kimbrough and Timothy M. Pawlik
Ethical Issues of the Mentor- Mentee Relationship . . . . . . . . . . . . . . . 97
Alberto R. Ferreres
Surgical Ethics and the Surgical Societies:
What Are We Doing? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Richard I. Whyte
Ethical Issues in Surgical Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Richard Jacobson, Laurel Mulder, and John Alverdy
Surgical Ethics and Diversity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Judith C. French and R. Matthew Walsh
Why and How to Teach Surgical Ethics? . . . . . . . . . . . . . . . . . . . . . . . 133
Jonathan K. Chica and Jason D. Keune
The Surgeon, the Patient, and the Healthcare System:
Access, Equity, and Fairness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Alexis G. Antunez and Andrew G. Shuman
vii
viii Contents
Ethics in Global Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Anji E. Wall
The Anesthesiologist and the Surgeon: Two Professionals
Sharing the Command of the Patient in the Operating Room . . . . . . 159
Anthony M. Roche and Gerald Dubowitz
Part II S urgical Ethics in Everyday Surgical Practice
The Surgeon-Patient Relationship: Built Upon Trust . . . . . . . . . . . . . 171
H. Alejandro Rodriguez and Carlos A. Pellegrini
The Transformation and Challenges of the
Surgeon–Patient Relationship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Piroska K. Kopar
The Surgical Decision-Making Process:
Different Ethical Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Christian J. Vercler and Sagar S. Deshpande
The Surgical Informed Consent Process: Myth or Reality? . . . . . . . . 203
Miguel A. Caínzos and Salustiano Gonzalez-Vinagre
Informed Consent and Disclosure of Surgeon Experience . . . . . . . . . 217
Sabha Ganai
The Pediatric Patient as a Self- Individual and Decision-Maker . . . . 231
Rosa Angelina Pace, Susana Ciruzzi, and Alberto R. Ferreres
End of Life Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Karen Brasel and Mary Condron
Ethics and Surgical Innovation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Maria S. Altieri and Aurora D. Pryor
Ethics and Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Amtul R. Carmichael and Kerstin Sandelin
Ethical Issues in Pediatric Liver Transplantation . . . . . . . . . . . . . . . . 265
Imventarza Oscar Cesar and Rojas Luis Daniel
Ethical Issues in Cardiothoracic Surgery . . . . . . . . . . . . . . . . . . . . . . . 271
Richard I. Whyte and Douglas E. Wood
Ethics of Surgical Intervention in Jehovah’s Witness Patients . . . . . . 283
Edward E. Cho and D. Rohan Jeyarajah
Ethical Issues in Bariatric Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Antonio J. Torres, Oscar Cano-Valderrama, and Inmaculada
Domínguez-Serrano
How to Solve Ethical Conflicts in Everyday
Surgical Practice: A Toolbox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Darren S. Bryan and Peter Angelos
Afterword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Contributors
Maria S. Altieri, MD, MS Division of Bariatric, Foregut and Advanced GI
Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY,
USA
John Alverdy, MD University of Chicago, Department of Surgery, Chicago,
IL, USA
Peter  Angelos, MD, PhD Department of Surgery, The University of
Chicago, Chicago, IL, USA
The MacLean Center for Medical Ethics, The University of Chicago, Chicago,
IL, USA
Alexis G. Antunez University of Michigan Medical School, Ann Arbor, MI,
USA
Karen Brasel, MD, MPH Department of Surgery, Oregon Health and
Science University, Portland, OR, USA
Douglas Brown, PhD Department of Surgery, Washington University in St.
Louis School of Medicine, St. Louis, MO, USA
Darren S. Bryan, MD Department of Surgery, The University of Chicago,
Chicago, IL, USA
The MacLean Center for Medical Ethics, The University of Chicago, Chicago,
IL, USA
Miguel A. Caínzos Department of Surgery, Hospital Clínico Universitario,
Santiago de Compostela, Spain
Georgina  D.  Campelia, PhD Department of Bioethics & Humanities,
University of Washington School of Medicine, & UW Medicine Ethics
Consultation Service, Seattle, WA, USA
Oscar  Cano-Valderrama, MD, PhD Department of Surgery, Hospital
Clínico San Carlos, Madrid, Spain
Amtul R. Carmichael Queens Hospital, Burton-on-Trent, UK
University of Aston, Birmingham, UK
Imventarza Oscar Cesar Hospital Argerich- Hospital Garrahan, Buenos
Aires, Argentina
ix
x Contributors
Jonathan K. Chica, MD St. Louis University, St. Louis, MO, USA
Edward  E.  Cho, MD Department of Surgery, Methodist Richardson
Medical Center, Richardson, TX, USA
Susana  Ciruzzi, JD, PhD Ethics Committee “Prof Juan P Garrahan”
Hospital and “Dr Alfredo Lanari” Institute, University of Buenos Aires,
Buenos Aires, Argentina
Mary Condron, MD Department of Surgery, Oregon Health and Science
University, Portland, OR, USA
Rojas Luis Daniel EAIT (Transplant Institute of Buenos Aires City), Buenos
Aires, Argentina
Sagar S. Deshpande University of Michigan Medical School, Ann Arbor,
MI, USA
Inmaculada  Domínguez-Serrano, MD, PhD Department of Surgery,
Hospital Clínico San Carlos, Madrid, Spain
Gerald Dubowitz University of California, San Francisco, San Francisco,
CA, USA
Denise M. Dudzinski, PhD, MTS Department of Bioethics & Humanities,
University of Washington School of Medicine, & UW Medicine Ethics
Consultation Service, Seattle, WA, USA
E. Christopher Ellison, MD, FACS Department of Surgery, The Ohio State
University, Columbus, OH, USA
Alberto  R.  Ferreres, MD, PhD, JD, MPH Department of Surgery,
University of Buenos Aires, Buenos Aires, Argentina
Department of Surgery, University of Washington, Seattle, WA, USA
Judith C. French, PhD Cleveland Clinic Lerner College of Medicine of the
Case Western Reserve University, Cleveland, OH, USA
Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
Sabha Ganai, MD, PhD, MPH, FACS Southern Illinois University School
of Medicine, Department of Surgery, Springfield, IL, USA
Salustiano  Gonzalez-Vinagre Department of Surgery, Hospital Clínico
Universitario, Santiago de Compostela, Spain
Richard Jacobson, MD University of Chicago, Department of Surgery,
Chicago, IL, USA
Rush University Medical Center, Department of Surgery, Chicago, IL, USA
D. Rohan Jeyarajah Department of Surgery, Methodist Richardson Medical
Center, Richardson, TX, USA
Jason D. Keune, MD, MBA, FACS St. Louis University, St. Louis, MO, USA
Charles W. Kimbrough, MD MPH Department of Surgery, The Ohio State
University, Wexner Medical Center, Columbus, OH, USA
Contributors xi
Piroska K. Kopar, MD Surgical Critical Care, Acute Care and Trauma
Surgery, Yale School of Medicine, New Haven, CT, USA
Cassandra C. Krause, MD, MA Department of Surgery, Loma Linda
University Health, Loma Linda, CA, USA
Laurel  Mulder, MD Rush University Medical Center, Department of
Surgery, Chicago, IL, USA
Jukes P. Namm, MD, FACS Department of Surgery, Center for Christian
Bioethics, Loma Linda University Health, Loma Linda, CA, USA
Rosa Angelina Pace, MD Ethics Committee Italian Hospital, Buenos Aires,
Argentina
Timothy M. Pawlik, MD, MPH, PhD Department of Surgery, The Urban
Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State
University, Wexner Medical Center, Columbus, OH, USA
Carlos A. Pellegrini, MD UW Medicine, University of Washington, Seattle,
WA, USA
Aurora D. Pryor, MD, FACS Division of Bariatric, Foregut and Advanced
GI Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook,
NY, USA
Anthony M. Roche University of Washington, Seattle, WA, USA
H.  Alejandro  Rodriguez, MD Department of Surgery, University of
Washington, Seattle, WA, USA
Kerstin  Sandelin Department of Molecular Medicine and Surgery,
Karolinska Insitutet, Stockholm, Sweden
Andrew  G.  Shuman, MD, FACS, FRCSEd (Hon) Department of
Otolaryngology-Head and Neck Surgery, University of Michigan Medical
School, Ann Arbor, MI, USA
Center for Bioethics and Social Sciences in Medicine, University of Michigan
Medical School, Ann Arbor, MI, USA
Steven M. Steinberg, MD, FACS Division of Trauma, Critical Care and
Burn, The Ohio State University, Columbus, OH, USA
Antonio J. Torres, MD, PhD, FACS, FASMBS Department of Surgery,
Hospital Clínico San Carlos, Madrid, Spain
Christian J. Vercler, MD, MA, FACS, FAAP Department of Surgery,
University of Michigan, Ann Arbor, MI, USA
Center for Bioethics & Social Sciences in Medicine, University of Michigan,
Ann Arbor, MI, USA
Anji  E.  Wall, MD, PhD Stanford University, Division of Abdominal
Transplantation, Palo Alto, CA, USA